Featured Research

Restricting elective surgeries, limiting incoming transfers and enhancing the efficiency of the discharge process helped one major hospital reduce capacity before a relocation without interrupting emergency or trauma services, according to a new report. Similar principles could help hospitals absorb patients in the aftermath of a disaster, the authors observe.

Share This

Restricting elective surgeries, limiting incoming transfers and enhancing the efficiency of the discharge process helped one major hospital reduce capacity before a relocation without interrupting emergency or trauma services, according to a report in the September issue of Archives of Surgery, one of the JAMA/Archives journals. Similar principles could help hospitals absorb patients in the aftermath of a disaster, the authors observe.

Related Articles

Planning to respond to natural or manmade disasters has become a priority for health care facilities around the world, according to background information in the article. "Thorough preparation requires a coordinated effort to determine the appropriate allocation of hospital resources to accommodate an acute influx of patients with needs for various services, including operative and other procedures," the authors write. Surge capacity is the term used to describe this ability to accommodate a sudden arrival of patients. "Surge capacity is rarely tested, as most disaster drills terminate after triage and immediate treatment in the emergency department and operating rooms."

UCLA Medical Center relocated to the new Ronald Reagan UCLA Medical Center site in June 2008, providing a unique opportunity to examine surge capacity issues. Howard C. Jen, M.D., and colleagues at the David Geffen School of Medicine, UCLA, analyzed hospital operations for one-week periods beginning two weeks and one week prior to move day. The researchers also analyzed regional hospital and emergency department capacity.

The medical center had an average daily census (point-in-time number of patients) of 525 patients before relocation planning began, and set a target of 350 patients for move day. "There were three components to our census management strategy," the authors write. "First, the elective surgery schedule was restricted beginning one week prior to move day, and operative volume was reduced by 45 percent. Second, incoming transfers were limited, leading to a reduction in both urgent and emergent admissions to medical and surgical services without limitation of trauma and emergency department admissions. Finally, a centralized multidisciplinary discharge team was used to enhance the efficiency of the discharge process."

Through these strategies, hospital census was reduced 36 percent, from 537 two weeks before move day to 345 on move day, with no change in rate of death among patients. Surgical services were reduced more than non-surgical services (46 percent vs. 30 percent); the number of elective operations decreased significantly while the number of emergency operations did not change. Hospital admissions decreased by 42 percent and discharges per occupied bed increased by 8 percent.

"The majority of our strategies required three to four days to achieve significant census gains and would be particularly useful during disasters, such as hurricanes or illness epidemics, with longer lead times," the authors write. "When lead times are brief, such as earthquakes, urban bombings or other mass casualty incidents, strategies to bolster emergency department and trauma center preparedness are the first priority. Inpatient capacity for continued hospital care of injured patients must also be generated simultaneously, and our model provides useful tools for this purpose."

The findings are particularly important given results of the analysis of regional capacity, which found that during a period in which the southern California population increased 8.5 percent, the number of acute care beds decreased by 3.3 percent. In addition, Los Angeles County emergency departments experienced a 13 percent diversion rate due to overcrowding. "Hospitals should create an internal plan using these principles of census management with modifications to reflect local characteristics," the authors conclude. "Finally, as many hospitals are currently operating at capacity, a regional and integrated systems approach to surge capacity creation is needed."

Featured Research

Mar. 31, 2015  Researchers have illuminated an important distinction between mice and humans: how human livers heal. The difference centers on a protein called PPAR alpha which activates liver ... full story

Mar. 31, 2015  Researchers have recorded the first direct observations of the micro-scale mechanisms behind the ability of skin to resist tearing. The results could be applied to the improvement of artificial skin, ... full story

Mar. 31, 2015  Fewer than half of the physicians trained in the United States in 2013 received formal education or training on the subject of exercise, according to new research. "There are immense medical benefits ... full story

Mar. 31, 2015  Memory and as well as connections between brain cells were restored in mice with a model of Alzheimer's given an experimental cancer drug, researchers report. "With this treatment, cells under ... full story

Mar. 31, 2015  Increasing state alcohol taxes could prevent thousands of deaths a year from car crashes, say researchers, who found alcohol-related motor vehicle crashes decreased after taxes on beer, wine and ... full story

Mar. 31, 2015  Alcoholism takes a toll on every aspect of a person's life, including skin problems. Now, a new research report helps explain why this happens and what might be done to address it. "The clinical ... full story

Mar. 31, 2015  A new population of 'memory' immune cells has been discovered by scientists, throwing light on what the body does when it sees a microbe for the second time. This insight, and others like it, will ... full story

Mar. 31, 2015  Coronary heart disease and stroke, two of the leading causes of death in the United States, are diseases associated with heightened platelet reactivity. A new study in humans suggests an underlying ... full story

Mar. 31, 2015  A new study had researchers seeking answers to why the therapeutic benefit afforded by SSRIs was so limited in children and teenagers. If researchers can uncover the biological mechanisms preventing ... full story

Featured Videos

Solitair Device Aims to Takes Guesswork out of Sun Safety

Reuters - Innovations Video Online (Mar. 31, 2015)  The Solitair device aims to take the confusion out of how much sunlight we should expose our skin to. Small enough to be worn as a tie or hair clip, it monitors the user&apos;s sun exposure by taking into account their skin pigment, location and schedule. Matthew Stock reports.
Video provided by Reuters

Soda, Salt and Sugar: The Next Generation of Taxes

Washington Post (Mar. 30, 2015)  Denisa Livingston, a health advocate for the Dinι Community Advocacy Alliance, and the Post&apos;s Abby Phillip discuss efforts around the country to make unhealthy food choices hurt your wallet as much as your waistline.
Video provided by Washington Post

S. Leone in New Anti-Ebola Lockdown

AFP (Mar. 28, 2015)  Sierra Leone imposed a three-day nationwide lockdown Friday for the second time in six months in a bid to prevent a resurgence of the deadly Ebola virus. Duration: 01:17
Video provided by AFP

Related Stories

Aug. 6, 2013  Mental health services should be integrated into disaster response as part of emergency services planning, according to a new study by UT Southwestern Medical Center psychiatrists who completed an ... full story

June 1, 2011  Emergency department patients who have recently been hospitalized are more than twice as likely to be admitted as those who have not recently been in the hospital, according to new ... full story

Mar. 1, 2011  When a disaster's physical evidence is gone -- debris removed, shooter arrested, ashes cold -- the psychological effects of the disaster on emergency responders and civilians involved still may ... full story

Feb. 18, 2011  Patients who undergo elective orthopedic surgeries at high-volume, regional hospitals have better surgical outcomes and experience fewer complications than those who undergo those surgeries at local ... full story

Oct. 3, 2010  A new study looks at the creation and evolution of a pediatric field hospital -- from a disaster service facility to a full-fledged children's hospital -- during the weeks and months following ... full story

ScienceDaily features breaking news and videos about the latest discoveries in health, technology, the environment, and more -- from major news services and leading universities, scientific journals, and research organizations.